BMJ Case Reports 2017; doi:10.1136/bcr-2017-219963
  • Reminder of important clinical lesson

Painful testicular metastasis from prostate adenocarcinoma

  1. Vincent Khoo1
  1. 1Clinical Oncology, Royal Marsden NHS Foundation Trust, London, UK
  2. 2Department of Urology, Imperial College Healthcare NHS Trust, London, UK
  3. 3Department of Surgery and Cancer, Imperial College London, London, UK
  1. Correspondence to Dr Karla A Lee, leeka{at}
  • Accepted 3 October 2017
  • Published 5 December 2017


A 60-year-old man presented with unilateral testicular pain and urinary frequency. His presenting prostate-specific antigen (PSA) was 100 ng/mL, and a biopsy revealed Gleason 4+4 prostate adenocarcinoma. The significance of his initial PSA was somewhat complicated by possible prostatitis and early initiation of bicalutamide. PSA rose on two occasions prior to radiotherapy but coincided with a flare of testicular pain on one of these. Whole-body staging diffusion-weighted MRI scan was negative. He was treated with 3 years of androgen deprivation therapy (ADT) and radical radiotherapy. PSA fell to undetectable levels on ADT. Twelve months following completion of ADT, PSA rose to 3.6 ng/mL. No disease recurrence was noted on restaging MRI pelvis. The patient was well, except for persistent testicular symptoms, which failed to resolve following multiple antibiotics. Testicular tumour markers were negative. Ultrasound findings were consistent with chronic epididymitis. A right orchidectomy was performed for symptomatic relief, confirming metastatic prostate adenocarcinoma.


  • Contributors KAL wrote the manuscript. EM and VK reviewed and approved it prior to submission.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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